The spectrum of comorbidities in patients with heart failure with preserved ejection fraction

Abstract

Introduction. Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases and is frequently associated with cardiovascular and metabolic comorbidities. The phenotype of HFpEF patients is heterogeneous, and the impact of comorbidities on prognosis, exercise capacity, and functional status remains insufficiently elucidated. Objective. The study aimed to characterize the clinical, functional, and comorbidity profiles of patients with HFpEF and to assess their influence on functional status, prognosis, and treatment response. Materials and methods. This was an observational, cross-sectional study including 206 patients with HFpEF (LVEF ≥50%) consecutively recruited from the General Cardiology Department of the Institute of Cardiology, aged ≥18 years, with an echocardiographically confirmed diagnosis. Demographic and anthropometric data, HFpEF etiology, hemodynamic biomarkers (NT-proBNP), functional status (NYHA), cardiovascular and non-cardiovascular comorbidities, and history of revascularization procedures (PCI, coronary bypass) were collected. Statistical analysis included descriptive statistics for continuous variables (mean ± SD, median, IQR), categorical variables (frequencies and percentages), and parametric/ nonparametric tests for correlations and subgroup analyses, with statistical significance set at P < 0.05. Results. The study population showed a typical overweight/obese profile, with arterial hypertension and chronic coronary artery disease as predominant mechanisms. Cardiovascular and metabolic comorbidities influenced exercise capacity, functional status, and treatment response, identifying distinct phenotypic subgroups with differential prognostic impact. Elevated NT-proBNP levels reflected increased ventricular filling pressures and functional heterogeneity, underscoring the need for individualized management. Conclusions. HFpEF is associated with a complex clinical profile dominated by hypertension, coronary artery disease, and metabolic comorbidities. Detailed assessment of comorbidities and biomarkers allows patient phenotyping and personalized therapeutic management. A multidisciplinary approach is essential for optimizing prognosis, exercise capacity, and quality of life in patients with HFpEF.